Maladaptive Eating Patterns After Weight‐Loss Surgery

Abstract

Weight-loss surgery has been shown to contribute to the improved health and well-being of the clinically severe obese, and for many has been seen as their "last resort." Although the majority of patients who choose this option as a means to achieve a healthier weight are successful, for some patients it is not beneficial. Bariatric surgery is not a panacea, and its immediate and long-term success depends on the patient's ability to incorporate lifestyle and behavioral changes. Patients who are not successful in achieving and maintaining their anticipated weight loss struggle to comply with diet, exercise, and vitamin regimens. Not only do these patients exhibit diminished weight loss, they have put themselves at risk for vitamin and mineral deficiencies and protein malnutrition. Their problematic response to weight-loss surgery may or may not be due to a worsening of presurgical depression, binge eating, emotion-triggered eating, body image, or eating behaviors associated with specific situations such as social events. This paper describes clinical responses we have observed in our bariatric practice. Several case studies are presented to highlight problems we have encountered when following bariatric surgery patients in the early postoperative period, as well as in a long-term setting. Recommendations are made for screening and follow-up of at-risk patients.

Adoption of Recommended Eating Behaviors Following Bariatric Surgery: Predicting Group Membership

“…With regard to bariatric surgery, some research has found support for the notion that some bariatric patients eat in response to emotional cues prior to surgery and report no incidences of emotionally triggered eating following surgery, whereas others continued to eat in response to emotional cues such as depression and anxiety (Saunders, 2004). Binge eating is another maladaptive eating pattern that has been found to affect the amount of weight lost and maintenance of weight losses among bariatric surgery patients (Rusch & Andris, 2007). Binge eating is not physically possible after surgery due to the reduction in the size of the stomach (Bocchieri et al, 2002a).…”

“…However, individuals dealing with binge eating may develop a different way to express binge eating, grazing, or snacking constantly throughout the day (Kalarchian, Wilson, Brolin, & Bradley, 1999;Rusch & Andris, 2007). Those individuals who continue to deal with binge eating and those who eat in response to emotional cues such as depressed mood and anxiety may be at greater risk for lapsing, a temporary slip or mistake, or relapsing (Brownell et al, 1986).…”

A psychiatric perspective view of bariatric surgery patients

“…However, some patients persist in their attempts to eat in response to stress or emotional events. Instead of the large amount they used to ingest before surgery, patients consume high-fat and sugar content food in smaller amounts or drink sugar-sweetened beverages, so they will experience minimal gastrointestinal adverse symptoms 43 . Snacking post-surgery has been associated with poor weight loss 35,44 .…”

“…Vomiting was reported by over 60% of the participants and self-induced vomiting with the goal of influencing shape and weight was admitted by 12% 37 . An intense fear of regaining weight or dissatisfaction with body image secondary to hanging skin, excessive preoccupation with weight and the use of restricting and purging behaviors have been referred by bariatric patients 15,43 . Furthermore, it was suggested that other postoperative undesirable events, such as "plugging" (problems with the small opening of the stomach becoming plugged with food) and dumping syndrome (intense discomfort after sweet ingestions accompanied by nausea, vomiting, bloating, cramping, diarrhea, dizziness, fatigue, weakness and sweating), may lead patients to engage in compensatory or restrictive behaviors.…”

Calidad de vida en pacientes operadas de bypass gástrico hace más de un año: Influencia del nivel socioeconómico

“…En nuestra experiencia, al realizar entrevistas clínicas semiestructuradas en pacientes en programa preparatorio para cirugía de bypass gástrico, 70% cumplió con los criterios para diagnosticar TCA en algún momento de su vida 38 , por lo tanto, a pesar de que las pacientes de esta muestra no presentaron mayor incidencia de TCA al compararlas con mujeres control, es un problema latente. Rusch y cols plantean ciertos criterios de riesgo para el desarrollo de TCA en el postoperatorio, tales como atracones, expectativas irreales con respecto a la cirugía, presión externa para bajar de peso, entre otros, y recomiendan controles periódicos para detectarlos, al menos durante los primeros 2 años de postoperatorio 39 . Al comparar el nivel de CV entre las mujeres operadas versus controles, encontramos diferencias significativas, especialmente en los indicadores de salud mental, siendo más marcadas las diferencias entre el grupo control de NSE alto y el grupo de operadas de NSE bajo.…”